How Nigeria's most vulnerable women are leading the fight against polio

Al Jazeera

4 days ago

Abuja and Nasarawa, Nigeria – In the neighbourhood of Kado Lifecamp on the outskirts of Nigeria's capital, 29-year-old Eucharia Joseph grips a cooler box and sets out for her day. Inside are oral polio vaccines packed in ice.
Joseph's route takes her through dusty lanes, past tin-roofed homes, mosques and churches. By nightfall, she and her team of six women will have vaccinated hundreds of children. Their mission: To ensure no child is left unprotected from the disease that once crippled thousands across the country.
In 2020, Nigeria was declared free of wild poliovirus by the World Health Organization (WHO) – a landmark achievement for a country once at the centre of global transmission. But the virus hasn't vanished entirely.
A related strain, known as circulating vaccine-derived poliovirus (cVDPV), still threatens under-immunised communities. Unlike the wild virus, cVDPV emerges when the weakened virus from oral vaccines mutates and spreads via contaminated food or water, for instance, in areas where too few children are vaccinated.
That threat remains. Despite steady progress, Nigeria still reports sporadic outbreaks of cVDPV. As of March this year, the country had reported 10 cases of the mutated strain. Last year, 98 cVDPV2 cases were reported.
With ongoing insecurity in northern Nigeria and pockets of resistance elsewhere, the job of eradicating polio now rests heavily on the shoulders of women like Joseph, who are often the only ones granted access to households due to a confluence of cultural, religious and safety reasons.
'It's my gift,' Joseph said of her work, as she adjusted her headscarf under the sun. 'I go to different localities. I talk to mothers. I sit with them. I know how to convince them. That's what makes this work possible.'
Women on the front lines
Female health workers like Joseph are the backbone of Nigeria's polio response.
In rural or conservative communities, male health workers are often not allowed to interact with women and children. While in conflict-affected areas, strange men moving between households may be viewed with suspicion, as many of these areas are battling rebels.
In Borno State – the epicentre of Nigeria's long-running Boko Haram rebellion and one of the regions hardest hit by polio outbreaks – the stakes are especially high. Male health workers have sometimes been suspected by the community of working with government forces or intelligence services.
In some neighbourhoods, the mistrust and resistance extend to female vaccinators as well.
'Most people in Maiduguri [the state capital] don't always like the vaccine. They think it prevents them from giving birth,' said Aishatu, who chose not to reveal her last name. The community health worker leads immunisation rounds across several wards in the area.
Such rumours about the effects of vaccines have circulated for years, often fanned by misinformation circulating among community networks, some religious leaders, and occasionally by armed groups such as Boko Haram, which has attacked vaccinators and portrayed immunisation as part of a foreign agenda.
In some cases, religious teachings have been misrepresented, for example, claims that vaccines are forbidden during certain religious festivals or that immunisation interferes with divine will. There have also been conspiracy theories saying vaccines are a Western plot to sterilise children.
Combined with longstanding mistrust of government programmes in some areas, belief in these rumours has made vaccine acceptance a persistent challenge in parts of northern Nigeria, health workers say.
For front-liners like Aishatu, confronting the beliefs has become part of the job. Her strategy is persistence and patience.
'We handle it by trying to increase sensitisation,' she said, referring to the repeated community visits, one-on-one conversations, and informal group talks that female health workers use to counter vaccine myths and build trust among hesitant parents. 'We keep talking to the mothers, telling them the truth. Some accept it slowly, some after seeing others take it.'
Aishatu has to balance this work with managing her household responsibilities. But she sees the job as something beyond a paycheck. 'The work is a professional one,' she said. 'But it also adds so much to life. I know I am helping people and I love it.'
But she also believes more needs to be done to expand the programme's reach. 'More female vaccinators are needed,' she said. 'That's the best approach for the government to use for creating more awareness about [the need and effectiveness of] polio vaccines.'
In areas or situations where male vaccinators face access constraints and restrictions, women doing the work have been more effective. And for some, their demeanour and approach to patients is what also makes a difference.
'Women are very social,' said Esu Danlami Audu, village head of Kado who has seen his village stamp out new polio cases because of efforts by women vaccinators.
'They are able to talk to parents, gain trust, and explain the importance of vaccines in ways men cannot. That is why they have played such an important role in our progress against eradication of poliovirus.'
This access has proven more critical in regions like Borno. According to the WHO, female vaccinators and community health promoters have been instrumental in reaching children in hard-to-access areas, sometimes even risking their lives to do so.
'All over Africa, despite facing life threats at many places, their [women vaccinators'] presence and persistence have helped overcome barriers of trust, cultural norms, and insecurity. This is especially true for conflict-affected areas of northern Nigeria where women are often the only ones allowed into households – especially those with young children – making their role irreplaceable,' said Dr Ndoutabe Modjirom, coordinator of WHO-led polio outbreaks rapid response team for the African region.
Innovation, persistence and economic ripple effect
To further counter these challenges, health workers have also adopted a mix of innovation and local knowledge.
Geographic Information System (GIS) mapping now helps identify missed settlements. Community mobilisers, often local women, monitor newborns and report missed vaccinations. Mobile health units and door-to-door outreach campaigns are routine.
'We go to schools, churches, mosques and markets,' said Aminat Oketi, a vaccinator in Nasarawa State and a mother of six. 'Sometimes we vaccinate 150, even 300 children a day. The work is tough. But when I see a child protected, it is worth it.'
Although Oketi earns some money from her work, the job is not well paid. Most vaccinators receive just 12,000 naira (about $8) from the government for a five-day campaign. Transport often eats into their earnings, forcing them to supplement this income with petty trade or hawking goods.
Aishatu supplements her income by running a small beans trading business in Maiduguri to earn an income. 'I buy and sell beans,' she said. 'I manage it by separating my time to work [as a health worker] and do business.'
While the campaigns has improved public health outcomes, it has also unintentionally created a foundation for economic empowerment among women, many say. Empowered by training and purpose, many of these women have become micro-entrepreneurs and informal community leaders.
Vaccinators like Oketi, who joined the programme four years ago, are not only safeguarding children but also building personal livelihoods.
She runs a small poultry business alongside her health work. 'I have a shop where I sell chicken feed and I rear birds too,' she said. Her modest vaccine stipend barely covers transport, but the exposure to community networks and the sense of mission have translated into entrepreneurial confidence.
'When people trust you with their children, they also trust you to provide them with other services,' she said. 'My customers come because they know me from the vaccination rounds. It is all connected.'
This is a common trajectory. While some female vaccinators have leveraged their community credibility to start small businesses, others, like Joseph, have set up informal health outreach networks, advising new mothers and coordinating care for sick children.
According to Cristian Munduate, UNICEF's country representative, this dual role of healthcare provider and entrepreneur reflects a deeper shift. 'They are not just women with jobs; they are agents of change,' she said. 'Vaccination campaigns have opened a pathway for leadership, agency, and financial independence.'
Helen Bulus, a government health officer in charge of vaccinations in Mararaba town in Nasarawa, reflects on the sense of commitment female health workers share.
'We are mothers too. Women take care of children, not just their own. That's why they don't give up [even when there is hardship],' she said.
And as they persevere, their work creates other positive ripples, like contributing to higher school enrolment among girls in some regions, she added. 'As mothers become more economically stable, they invest more in their daughters' futures.'
A global model – with challenges
While wild polio now remains endemic only in Pakistan and Afghanistan, Nigeria's experience offers vital lessons. Its fight against polio, led by women, supported by community trust, and bolstered by innovative strategies, has reshaped how public health can be delivered in fragile settings.
The next step, experts say, is sustaining this momentum.
'Routine immunisation must be strengthened,' said Munduate. 'And communities must be supported, not just during outbreaks but all year round.'
The polio infrastructure has also transformed Nigeria's broader healthcare system. Cold chains, data systems, and human networks developed for polio now support routine immunisations, maternal health, and even responses to outbreaks like cholera and COVID-19.
'We have built a legacy platform. Female vaccinators trained for polio are now part of nutrition drives, health education, and emergency response. They have become health champions,' WHO's Modjirom explained.
Still, hurdles persist. Insecurity continues to hinder access in parts of northern Nigeria. In conservative areas, misinformation remains rife, fed by rumours that vaccines cause infertility or are part of foreign agendas.
Despite gains, health workers say there is little scope for complacency. Experts warn that until every child is reached, the virus remains a threat not just to Nigeria, but to global eradication efforts.
'For each paralytic case, thousands more may be infected,' said Munduate. 'That's why we can't stop and efforts have to continue.'
The reporting for this story was supported by UN Foundation Polio Press Fellowship